Ajay Babu K, Harish Y. S
BACKGROUND The symptoms of abdominal tuberculosis are generally vague and nonspecific. It may mimic any intra-abdominal disease and can challenge the diagnostic skills. Tuberculosis of the Ileocaecal region ranks first in incidence among abdominal tuberculosis. Abdominal tuberculosis denotes involvement of the gastrointestinal tract, peritoneum, lymph nodes, and solid viscera, e.g., liver, spleen, pancreas, etc. The gastrointestinal tract is involved in 65% to 78% of patients; associated peritoneal and lymph node involvement is common in these patients. The management of gastrointestinal tuberculosis is still controversial. Surgery is done for complications such as obstruction, perforation, fistula, or a mass which does not resolve with medical therapy. The aim of this study is to evaluate the surgical management of abdominal tuberculosis. MATERIALS AND METHODS A clinical study of fifty cases of abdominal tuberculosis treated surgically in different surgical units of tertiary care center, Tirupati from July 2015 to October 2016. A collection of common and rare manifestations of abdominal tuberculosis is presented hereunder. Stress was laid upon a thorough history taking and physical examination. The different surgical procedures were enumerated. All the routine investigations concerning the disease were done; a few were subjected to special investigations. The ensuing complications of the treatment were studied, and the cases were followed up. RESULTS The signs and symptoms of intestinal tuberculosis are nonspecific, and there are no unequivocal diagnostic features either clinically or radiologically. The most common presenting complaint was abdominal pain and the most common sign was abdominal tenderness. As a result, laparotomy and histopathological examination were frequently necessary to establish confirmatory diagnosis. It commonly affects the adults in their 3rd and 4th decades. Notably the earning age group hence can have economic implications. Also, females are affected at slightly younger age than males. The M: F ratio in the present series was 3:2. Patients commonly present with one of the complications and the most common among them is intestinal obstruction. Patients who present with a mass are of slightly higher age group and those presenting with a perforation are relatively younger. Early diagnosis is the key factor in avoiding systemic and local complications of intestinal tuberculosis. Hence a high index of clinical suspicion is needed. It was more difficult in cases of emergency laparotomy, the nature of the obstruction may go unrecognized, particularly in patients having acute symptoms, or caecal masses may be thought to be malignant. The most common diagnosis made was that of sub-acute intestinal obstruction (40%). CONCLUSION The approach to surgery should be conservative, with the aim of saving maximum bowel length, so stricturoplasty and anastomosis were the most common surgeries performed (34%) in the present series. A definitive procedure in the form of resection of diseased segment and primary anastomosis has done. But in presence of gross peritonitis, a two-stage procedure with a temporary ileostomy is preferable and safe. While other procedures like perforation closure, adhesiolysis, limited resection and right hemi colectomy are done. Wound infection is common, but most of them respond well to Anti Tubercular Treatment (ATT), so all patients should be started on 6 months of ATT, post operatively. Mortality is only 2%.
